Uthando luka-Okthoba 2017 lwe-Trump luyothinta kanjani umshuwalense wezempilo?
Ngo-Okthoba 12, 2017, uMongameli Trump wasayina i-oda eliphezulu "ukugqugquzela ukukhetha kwezempilo kanye nokuncintisana kuwo wonke ama-United States." I-oda lokuphatha lafika nje nje amahora ambalwa ngaphambi kokuba i-Trump Administration yamemezele ukuthi izimali zokunciphisa izindleko ze-ACA (CSR) zizophela ngokushesha , ngakho akumangazi ukuthi umphumela we-executive order kanye nokuxhaswa kwezimali kwe-CSR ngezinye izikhathi kuvunyelwe.
Kodwa ngenkathi ukuxhaswa kwezimali ze-CSR kwakuyisenzo esicacile esasisebenza ngokushesha, umyalo wokuphatha awuzange wenze noma yiziphi izinguquko kuye futhi, futhi imiphumela yayo izosithatha isikhathi sokuzihlanganisa. I-oda eliphezulu liqondisa ama-ejensi ahlukene e-federal ukuba "acabangele ukuphakamisa imithetho" ukwenza izinguquko ezihlukahlukene emithethweni ephathelene nomshuwalense wezempilo wesikhathi esifushane, izinhlelo zezempilo, kanye nezinhlelo zokubuyisela impilo (HRAs). Lezo ziqondiso kuzodingeka zihambe ngokusebenzisa inqubo ejwayelekile yokwenza umthetho, okufaka isikhathi sokuphawula komphakathi.
Ake sibuke ukuthi lezo zinguquko zingase ziphi, nokuthi zingathinta kanjani umshuwalense wakho wezempilo.
Umshwalense Wezempilo Wesikhashana
Umshuwalense wesikhashana esifushane, isikhathi esincane (STLDI) yilokho okuzwakala sengathi: umshuwalense wezempilo ukuthi ungahlala isikhathi esilinganiselwe kuphela. Kodwa ubude besikhathi umuntu okufanele akwazi ukufinyelela ngayo isikhathi esifushane sekuphikisana eminyakeni yamuva.
Umshuwalense wezempilo wesikhathi esifushane awulawulwa uMthetho Wokunakekelwa Onganakekelwayo. Ngakho ukufaneleka kwabafakizicelo zokusabalalisa kusekelwe emlandweni wabo wezokwelapha, izimo ezikhona ngaphambili azihlanganisiwe, ama- maximum wokuphila kanye nonyaka ayasebenza, futhi izinhlelo azidingeki zimboze izinzuzo zezempilo ezidingekayo ze-ACA .
Imithetho yokulahlekelwa kwezokwelapha (MLR) imithetho ayisebenzi kumacebo ambalwa, ngakho-ke akukho mfuneko yokuthi iningi lamaphrimiyamu lisetshenziselwe izimangalo zezokwelapha.
Ngamafuphi, lezi zinhlelo zifana nezindlela eziningi kwezinye izinhlelo ezinkulu zokwelapha ezazingathengiswa emazweni amaningi ngaphambi kuka-2014. I-ACA ivimbela ukudayiswa kwamacebo afana nalokhu emakethe enkulu yezokwelapha kusukela ngo-2014, kodwa Imithetho emisha ayisebenzi ezinhlelweni zesikhathi esifushane.
Njengoba izinhlelo zesikhathi esifushane zikwazi ukuqhubeka zihlinzeke ngokunikeza abantu abanempilo enemikhawulo eqinile ezinsizeni, futhi ngoba izinhlelo zinezinkathi ezilinganiselwe, ama-premium avame ukuba aphansi kakhulu kunama-premium amanani aphelele emakethe ehambisana ne-ACA (kokubili noma okungahambisani naye, njengamalungiselelo amakhulu kwezokwelapha okudingekayo adingeke ukuba alandele imithetho efanayo ngaphandle kokushintshaniswa abayilandela ngaphakathi kwezokushintshaniswa).
Ngaphambi kuka-2017, incazelo yenhlangano yesikhashana esifushane yayiyi-coverage eyayinezinsuku ezingama-364. Amanye ama-state ayenemithetho eqinile (abambalwa abavumeli izinhlelo zesikhathi esifushane nhlobo, kanti ezinye zazinciphisa izinyanga eziyisithupha), futhi abaningi bomshuwalense banciphisa izinhlelo zabo zesikhathi esifushane ezitholakalayo ezinyangeni eziyisithupha ngesikhathi eside, kungakhathaliseki ukuthi ziguquguquke kanjani uhulumeni noma uhulumeni wesifundazwe.
Kodwa emazweni amaningi, kwakukhona okungenani izinhlelo ezimbalwa zesikhathi esifushane ezitholakalayo ngezikhathi cishe zonyaka.
Ukubhaliswa kulezi zinhlelo kwanda emva kokuhlinzekwa kwe-ACA, njengoba abantu befuna ezinye izindlela ezingathengi ku-ACA-yokubambisana okuhambisanayo. I-ACA yenza ukuthengwa kwamakethe okuthengwa ngabanye abakwazi ukukhokhela izinzuzo ze- premium , kodwa labo abanenzuzo engaphezulu kwamaphesenti angama-400 ezingeni lobuphofu (okungukuthi, abafanelekile ukuthola izinsizakalo ze-premium) ngezinye izikhathi bathola ukuthi izinhlelo eziba khona zingaphezu kwalokho isabelo-mali sizovumela.
Kulaba bantu ngabanye, uma nje bephilile, uhlelo oluthile lwesikhashana lungase lunikeze okunye okusemandleni okungaqinisekisiwe.
Kodwa izinhlelo zesikhashana zinezinkinga ezinkulu (ukuthi abantu abazi njalo kuze kube yilapho bezithola benesidingo sokunakekelwa kwezempilo okungathí sina), futhi lapho abantu abanempilo bephuma echibini lezinhlekelele ezihambisana ne-ACA ngokuqondene nezinye izindlela, kushiya konke indawo yokubeka ingozi yezinhlelo ze-ACA-ezivumelanisa kakhulu ezibhekiselele kubhalisa abagulayo, okuholela emakethe engaqiniseki.
Nakuba abantu abathembele kumshuwalense wesikhashana bangekho ngaphansi kwesigwebo semfanelo esabelwe ngokuhlanganyela sika-ACA kusukela ngo-2014 (ngoba umshuwalense wesikhathi esifushane awubhekwa njengobuncane bokubaluleka okubalulekile), i-Obama Administration yanquma ukuphakamisa imithethonqubo futhi iqinisekise ukuthi umshuwalense wesikhashana ingasetshenziswa kuphela njengoba yayihloselwe ekuqaleni: ukugcwalisa igebe elincane phakathi kwamanye amaphuzu omshwalense wezempilo, hhayi njengengxenye yesikhathi eside yomshuwalense wezempilo wangempela.
Ngakho basebenzise imithethonqubo ngasekupheleni kuka-2016 (okwaqala ukusebenza ngoJanuwari 2017 futhi kwaphoqelelwa kusukela ngo-Ephreli 2017) okwehlisa izinhlelo zesikhathi esifushane izinyanga ezintathu esikhathini eside.
I-oda lokuphatha likaTrump cishe lizoholela emithethweni emisha ezobuyisela umthethonqubo we-2016 nokubuyiselwa umthetho owandulele owavumela izinhlelo zesikhathi esifushane ukuba zibe nezinsuku ezingu-364. Kodwa abantu abathembele emigodini yesikhathi esifushane bazobe bengaphansi kwesigwebo somthwalo esabelwe u-ACA, njengoba umshuwalense wesikhathi esifushane usazobhekwa njengenzuzo engekho ngaphandle, ngakho-ke akuyona inzuzo ebalulekile ebalulekile.
Kukhona ukukhathazeka okubuyiselwa emuva kwemithethonqubo emigqeni yesikhathi esifushane kuzosusa imakethe ngayinye ehambisana ne-ACA. Kodwa abanye bathi cishe bazogcina imithetho engavinjelwe eyayiba nayo ngaphambi kuka-2016, kanti abanye bangase babe nemithetho efanayo ukuze bavikele izimakethe ezinkulu zezokwelapha zabo ze-ACA.
Izinhlelo Zempilo Yenhlangano
I-oda lokuphatha likaTrump libiza ukuthi "ukwandisa ukufinyelela" ezinhlelweni zezempilo zenhlangano (AHPs), ukuze uvumele amabhizinisi amancane ukuba ajoyine ndawonye futhi athole ukumbozwa kweqembu elikhulu (kuthengwa kusuka kumshwalense noma onesiqiniseko), kunokuba ibhizinisi ngalinye lizithenge uhlelo lweqembu elincane.
I-ACA inqume iningi lemithetho yalo emakethe yeqembu ngalinye namancane. Nakuba abaqashi abakhulu (abasebenzi abangu-50 + kuphela kuphela abadingwa ngumthetho ukunikeza ukuhlinzekwa kwabasebenzi, ukuthengwa kwamaqembu amancane angayithenga kulawulwa ngokweqile kunokuba kutholakale amaqembu amakhulu.
Ukuze kutholakale ukuphumelela ngoJanuwari 2014 noma kamuva, i-ACA idinga ama-premium amaqembu amancane ukuba asekelwe eminyakeni yobudala kuphela, ukusetshenziswa kogwayi, nendawo yokuhlala-isimo sezempilo jikelele seqembu asikwazi ukusetshenziselwa ukunquma amaphrimiyamu. Futhi amacebo amancane amaqembu adingekayo ukumboza izinzuzo ezibalulekile zezempilo ze - ACA . Ayikho yalezi zidingo ezisebenzayo kumacebo amakhulu eqembu (iningi lamapulani amaningi eqenjini lizimele, kodwa lezo zimfuneko ze-ACA azizisebenzisi noma iyiphi indlela).
Ngakho umqondo nge-AHPs ukuvumela amaqembu amancane ukuba ahlanganise ndawonye ukuze akhe amaqembu amakhulu, futhi agweme ezinye zezimiso ze-ACA kwinqubo. Kodwa ngenkathi umqashi omkhulu we-Bonafide enesithakazelo esiqinisekisiwe ekuqinisekiseni ukuthi abasebenzi bakhe bahlala bephilile futhi izinzuzo zezempilo ziqinile ngokwanele ukuba zibe ithuluzi eliqinile lokuqasha nokugcina, okungenzeka ukuthi akulona iqiniso ohlelweni lwezempilo lomphakathi.
Futhi nakuba umqashi omkhulu kufanele acabange isikhathi eside mayelana nesisindo sazo zonke izinzuzo, akukho lutho oluvimbela ibhizinisi elincane ukungena ku-AHP ngenkathi abasebenzi bayo bephilile, bese bebuyela emakethe yeqembu elincane elihambisana ne-ACA ngosuku oluthile uma lokho kukhetho kwakufanele kube okukhangayo ngokusekelwe ezimweni ezishintshile. Ngakho kukhona ukukhathazeka ukuthi ukwandisa ububanzi be-AHPs kungahle kuhlasele imakethe yeqembu elincane elihambisana ne-ACA ngokuheha amaqembu amancane aphilile emakethe ehambisana ne-ACA futhi abe yi-AHPs.
Amalungiselelo Okubuyiselwa Kwezempilo
I-oda eliphezulu libiza nemithethonqubo emisha "yokwandisa ukuguquguquka kwemvelo nokusebenzisa" amalungiselelo okubuyiselwa kwempilo (HRAs). Umqondo, ngokuyinhloko, ukuvumela abaqashi ukuthi basebenzise ama-HRA ukuze babuyiselwe abasebenzi ngenxa yamaphrimiyamu omakethe.
Abaqashi babekwazi ukwenza lokhu. Kodwa yavinjelwa ngokuphelele ngaphansi kwemithethonqubo yokuqala eyabhalwa ukuba isebenzise i-ACA (ukuvinjelwa kwakuhambisana nehlawulo elihle kakhulu: $ 100 ngosuku ngosuku lomsebenzi uma umqashi eqhubeka nokubuyisela abasebenzi ngenxa yamaphrimiyamu athile emakethe). Umkhawulo wawuncishiswa kancane yi-21st Century Cures Act, owaqala ukusebenza ngo-2017 futhi uvumela abaqashi abancane (abasebenzi abangaphansi kuka-50) ukuthi babuyisele imali ye-premium yemali yomshuwalense wezempilo emakethe kuze kube yilapho isamba semali ye-dollar esetshenzisiwe, besebenzisa ama-HRAs.
Kodwa abaqashi abancane abadingeki ukuba banikeze ukukhokhelwa kuzo zonke ngaphansi kwe-ACA, kuyilapho abaqashi abakhulu bekhona. Futhi okwamanje akakho ukuhlinzekwa okuvumela abaqashi abakhulu ukuba babuyiselwe abasebenzi ngenxa yamaphrimiyamu omakethe ngamunye. Abasebenzi bakhululekile ukuthola noma yiluphi uhlobo lomshuwalense abawuthandayo-ukwamukela ukunikezwa komqashi wabo we-inshuwalense yezempilo yeqembu, noma ukuthenga ukuthenga emakethe ngayinye-kodwa umqashi omkhulu akakwazi ukukhokhela ukuthengiswa kwemakethe ngayinye (ngokuphambene, isisebenzi asikwazi ukufinyelela izinsizakalo ze-premium imakethe ngayinye uma umqashi ehlinzeka ngemali engabizi, umshuwalense wempilo yeqembu elincane).
I-oda lokuphatha likaTrump kulindeleke ukuthi liholele emithethweni ehlongozwayo eyokwenza ukwandisa ukuguquguquka kwabaqashi ukusebenzisa i-HRAs ukubuyisela abasebenzi kwi-premium yemakethe, ngisho noma umqashi enabasebenzi abangu-50 noma ngaphezulu.
Lokho esingakasazi khona ububanzi bemithetho ehlongozwayo. Ingabe kuphela ukufakwa kwe-ACA-okuhambisanayo okumele kuthathwe njengokufanelekile ukubuyisela imali, noma ngabe ngaphandle kwezinzuzo (njengezinhlelo eziseduze zesikhashana) kufaneleke? Abaqashi abakhulu babezocatshangelwa ngokuhambisana nomsebenzi womqashi (okungukuthi, imfuneko abayinikezelayo noma okungenzeka bakhokhele inhlawulo) uma basebenzisa ama-HRA ukuze babuyiselwe amaphrimiyamu omakethe kunokuba banikeze ukufakwa kweqembu?
Sizowubona Nini Imithetho Emisha?
Kuningi okumele kubonwe ngokuvumelana nalokho okuhlongozwayo emithethweni ezayo. Imithethonqubo ye-AHPs nomshuwalense wezempilo wesikhathi esifushane kulindeleke ukuba ihlongozwe zingakapheli izinsuku ezingama-60 kusukela ngosuku lokuhleleka, ngakho kufanele sibone ngaphambi kokuphela konyaka. Futhi imithethonqubo ephathelene nama-HRA kulindeleke ukuthi ihlongozwe zingakapheli izinsuku ezingu-120, ngakho kufanele itholakale ekuqaleni kuka-2018.
Ngemuva kokuthi imithethonqubo ehlongozwayo ishicilelwe, kuyoba khona isikhathi sokuphawula esidlangalaleni ngaphambi kokuba sisebenze, ngakho-ke uma unempendulo yezinhlaka zikahulumeni ezisebenza ngalezi zinkinga, lokho kuzoba ithuba lokulihlanganyela.
> Imithombo:
> UMnyango Wezezimali; Umnyango Wezabasebenzi; UMnyango wezeMpilo kanye nezinsizakalo zabasebenzi. Izinzuzo ezingeziwe, Imikhawulo yokuphila kanye nonyaka, kanye noMshuwalense Wesikhathi Esifishane Nesikhathi Esifishane . Okthoba 2016.
> I-White House, iHhovisi likaNobhala Wezindaba. I-oda elihle likaMengameli likhuthaza ukukhethwa kwezempilo kanye nokuncintisana phakathi kwe-United States. Okthoba 12, 2017.